SUMMER CAMP REGISTRATION FORM

SUMMER CAMP REGISTRATION

PH: 985-606.0815 • FAX: 985-606.0816 CELL: 985.634.3577
STUDENT INFORMATION:

First NameLast Name
GENDER
DOB

MonthDayYear
Date
T-SHIRT SIZE:(SPECIFY ADULT OR CHILD)
PARENT OR GUARDIAN NAME:

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
(if Mailing address is different, fill in below)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does Student have any Special Needs or Allergies?
***Non-Refundable $150 registration fee is required to reserve a slot. CCAP is accepted but not required. Please present this form with payment.
Should be Empty: